This is a finding that keeps coming up, and I've certainly found it true in my life, but there's a significant chicken-and-egg problem in that depression frequently precludes the motivation to exercise, and if you don't already have a deeply-disciplined routine to overcome the lack of motivation, people won't do it.
Exhortation to develop those good habits in the good times, I suppose.
That is true. And motivation is not a fixed variable. It is possible to get increased motivation by a better plan, resulting in increased self efficacy.
From studies like this, maybe more awareness and perhaps funding to solutions providing smaller steps
Shameless plug, I am building one: Low friction mini games, social, squats/situps/pushups. Feelgoodcrew.com
i think what is missing from this narrative is not whether or not people have a routine, it is that exercise elevates your mood away from the depressed state, therapy encourages you to question your thoughts and decisions through out your day that might lead you away from a depressed state. to put it a different way, whats the point of exercising every day if you continue the thoughts and habits that are less than satisfactory to you without any self awareness?
My two cents on this topic is to create short term, superficial incentives to help create the practices that yield the long term incentives. For me this is paying extra for a gym with a hot tub, sauna, and cold plunge. Now I derive relaxation from the workout, but before that I also received a lot of support from the knowledge that the amenities afterwards were waiting for me.
One thing that worked well for me is I switched my transportation to almost exclusively bicycle. Do I always want to exercise? Do I always want to get on my bike when it's below zero in active weather? No, not always. But if I want to get where I'm going that's my option and I get the exercise in the process (and save a buttload of money too)
I think we also approach exercise the wrong way. And IMO this is true with sleep too (which also impacts depression). We're using the wrong metrics.
The most important thing to get started with working out is just to start doing some exercise. You can start on one push up a day or something. It's all about creating momentum and habit.
Once you do it, then you can increase the time and the intensity and optimize exercise and all. But doing sport should be about doing one push up a day and thats it. About starting as slow as you can.
Sleep is the same in that we try to sleep as much as we can, and get as much REM and deep sleep, and these are not the right metrics for most people. The most important is just to go to bed and wake up at the same time everyday. That's it.
People are obsessed with trying to go to sleep at some point in time. Don't. Go to sleep when you're tired, wake up sleep deprived at the right time, the next evening it'll be easier to sleep at the right time
This seems to work for me at least. If I start trying to reason with myself why I should get out of bed at 5am to go to the gym rather than excuse XYZ, I will talk myself out of it.
If I simply start "moving" and start doing "stuff" without engaging my brain, things happen and within a short space of time, I'm pumping iron and feeling great.
Fun fact, people suffering from loss of quality of life issues don't lack motivation. Lots of these people are in great pain, constantly, every day. My mother had a hip issue where the pain could instantly shoot up so bad she couldn't move (from just the normal, constant, almost in tears pain). She couldn't risk going somewhere to exercise, she would be stuck. She couldn't risk exercising on days where she needed to work the next day. Some days she would break down crying going to the grocery store because she had gotten stuck there the previous time she went.
A LOT of quiet unassuming people are INSPIRINGLY motivated to push through INCREDIBLE pain and obstacles, every day. Many that prevent them from 'just exercising until life gets better'. It is bullshit to say they lack motivation/character/willpower.
I don’t think that conclusion follows. These results don’t mean “barely effective.” They mean that, on average, people who get therapy or exercise end up noticeably better off than people who don’t. When researchers translate the results into intuitive terms, therapy typically moves the average person from the middle of the pack to around the top 30 percent, and exercise to roughly the top 35 percent. That’s the same general magnitude of benefit seen with many approved medications, including antidepressants themselves. Depression trials have large placebo effects, which makes the numbers look smaller, but that doesn’t mean the treatments are doing almost nothing.
I will speak from my experience. I have diabetes and I try to manage it well, with workout. But sometimes when the sugars are high for a while, I can feel it, the sadness, the hopelessness. It took me a while to understand that is high sugar levels and a mild form of depression. Now I will do some workout when I feel that and after a little workout, I can see how my mind also start to feel better. This is not a solution for everyone who is experiencing depression probably but might help some who are experiencing because of high sugar levels.
If it helps anyone I take antidepressants and have had a positive experience with them. Depression can be caused by a chemical imbalance and no amount of exercise or talking about it will fix it.
One of the most frustrating things when your really low is people giving advice like do exercise to feel better - please don’t do this.
Yes, exactly. I have exercised daily (either weight training or cardio) for nearly 20 years. I've also had anxiety and depression for that entire stretch of time.
Exercise was how I stayed mildly sane for a good majority of those years, but when I started taking medication it was like the entire world changed. I wish I had started earlier in life. It helped me to become a lot more introspective as well, being able to better examine why I was feeling the way I did.
There are some things that no amount of exercise or "healthy living" can fix, that's unfortunately just the human condition. It's nothing to be ashamed of.
Usual antidepressants (reuptake inhibitors) have specific chemical and clinical effects. Some forms of depression, mostly with stress, respond heavily, others, like refractory and bipolar, show no effect. It's like saying a knife cannot cut an arbitrary material. It depends. Studies of ADs must start to differentiate at least a few subtypes of depression.
I decided to go unmedicated from SSRIs/mood stabilizers in 2024 and it changed my life for the better. Prior to stopping, I thought I was physically unhealthy until I found out excessive overheating & exhaustion was a common side effect of Zoloft. Since then, I've lost around 40 pounds and have been able to regularly exercise without issues. My mental health also improved with forcing myself to get vitamin D outside. It can be the simplest of things to improve your life, but it can be easy to forget (especially WFH).
> For the 57 trials (2189 participants) comparing exercise with no treatment or a control intervention, the pooled SMD for depressive symptoms at the end of treatment was −0.67 (95% confidence interval (CI) −0.82 to −0.52; low‐certainty evidence), showing that exercise may result in a reduction in depressive symptoms. When we included only the seven trials (447 participants) with adequate allocation concealment, intention‐to‐treat analysis and blinded outcome assessment, the pooled SMD was smaller (SMD −0.46, 95% CI −0.88 to −0.04). Pooled data from the nine trials (405 participants) with long‐term follow‐up provided very uncertain evidence about the effect of exercise on depressive symptoms (SMD −0.53, 95% CI −1.11 to 0.06; very low certainty evidence).
Like, what does -0.67 really mean in this context. I read the study and it is not really explained. Maybe I'm too dumb to get it, though.
I found this to be contradictory with my mental health period even after losing nearly 100 pounds, and going from zero to walking 8 to 10 miles a day, my mental health did not improve. It felt good to accomplish goals, two life-changing goals, really, but my overall disposition and deep depression did not change. I have no explanation for this.
I took meds for depression a few years ago. I don't know that they did anything other than signal to myself that I wasn't ready to give up. They may have served as a kind of "dumbo's feather" that helped me get through a rough patch. Exercise might be similar. People who choose to exercise make the statement to themselves that they are worth doing something positive for. Some mental health problems resolve with time and without medication, and in those cases, exercise might be a great way to address them. But if you're struggling, call your doctor and make and appointment. Medication is sometimes the answer.
I think one of the tricky things about depression is how unique each person's experience with it can be. I can only speak from my own history. For me, medication was indispensable in getting me to a point where lifestyle changes could occur.
That being said, I do believe that exercising, eating right, maintaining a healthy sleep schedule, etc., all the boring lifestyle things have been key to preventing myself from slipping back into that depressed state, years after stopping medication.
It’s also fantastic for anxiety, or at least it has been for me. Though I’ve heard anxiety and depression are often linked so I wonder if there’s some common underlying mechanism by which it helps either both.
I would assume that "doing something" is the key here? Successfully doing exercise probably has add on benefits that you can more successfully do other things afterward. But successfully reading a book can help me get out of depression. Successfully cleaning the kitchen. Really, just successfully doing anything is a huge cure against depression.
The audiobook Spark by Dr. John Ratey, psychiatrist is a great listen with a bunch more evidence based arguments to support that exercise is better then drugs for depression.
I highly recommend the audiobook as it is read by him and he is very enthusiastic about his research.
The one quote I remember from the book is that he stopped prescribing Prozac and started prescribing treadmills...
It's in my top 15 books that changed my worldview.
Some key highlights:
1. In 2001 fit kids scored twice as well on academic tests as their unfit peers.
2. German researchers found that people learn vocabulary words 20 percent faster following exercise than they did before exercise, and that the rate of learning correlated directly with levels of BDNF.
3.Specifically, every fifty minutes of weekly exercise correlated to a 50 percent drop in the odds of being depressed.
Unfortunately, if exercise is only nearly as effective as therapy for depression, it may mean that the benefits of exercise are not actually really clinically observable, if measured properly and not just based on arbitrary statistical significance.
Standardized effect sizes like the ones reported here have no clinical meaning, they are purely statistical. To measure if these kinds of changes matter, you need to determine the Minimal (Clinically) Important Difference [1-2]. I.e. can clinicians (or patients) even notice the observed statistical difference.
In practice, this is a change of about 3-5 points on most 20+ item rating scales, or a relative reduction of 20-30% of the total (sum) score of the scale [1-2]. Unfortunately, anti-depressants are under or just barely reach this threshold [3-4], and so should be widely to be considered ineffective or only borderline effective, on average. Of course this is complicated by the fact that some people get worse on these treatments, and some people experience dramatic improvements, but, still, the point is, depression is extremely hard to treat.
EDIT: There is less data on MCIDs for therapy, but at least one review suggests therapy effects can be in the 10+ point range [5]. But the way the exercise study is presented, with a standardized effect size, we can have no idea if the results matter at all [6].
[2] Masson, S. C., & Tejani, A. M. (2013). Minimum clinically important differences identified for commonly used depression rating scales. Journal of clinical epidemiology, 66(7), 805-807. [https://www.jclinepi.com/article/S0895-4356(13)00056-5/fullt...]
[5] Cuijpers, P., Karyotaki, E., Weitz, E., Andersson, G., Hollon, S. D., & van Straten, A. (2014). The effects of psychotherapies for major depression in adults on remission, recovery and improvement: a meta-analysis. Journal of affective disorders, 159, 118–126. https://doi.org/10.1016/j.jad.2014.02.026 [shevy-java↗
This kind of makes sense. Most forms of depression have to do with
not wanting to do something or lacking motivation to do so. Whereas
in sports, people get busy usually, they do something, even if it may
just be soccer playing. Exercise is also usually good for one's
physical well-being, blood circulation increases, muscles may improve,
pain may go away (depends on the exercise, but usually say, two days
after some heavy work out, most people may feel better than before,
unless it was some extreme exercise that caused injury).
I don't think this works for all type of depression though.
Therapy carries a huge risk, so maybe if you compare average outcomes exercise is only nearly as effective, but if you consider the 2 overall exercise comes out way, way ahead imho.
Exercise is great, just make sure to take sometime to evaluate where you are at mentally. I was running about 40 miles and doing 5 hours of lifting per week to try and stay a head of my depression, and when I finally burnt out everything came crashing down all at once.
There is a tri-lateral(?) relationship between exercise, sleep, diet, and how the three impact mental health.
A waste product of exercise is Adenosine. Adenosine build-up leads to increased sleep pressure, and improved Neural Function of Sleep, not just "being unconscious".
This is where things get a bit interesting when we look at depression. For many people, depression results in decreased Neural Function of Sleep (specifically slow-wave activity) even though sleep time often increases.
However there is also some evidence that restricting slow-wave activity can act as a "reset" button. The researchers I have spoken to about this are either in the "too dangerous to do the research" camp, or "distrupting slow-waves for a very short period, then increase slow-wave activity".
Of course, sleep and exercise would only be a single pathway to improving depression outcomes. Exercise alone, and the dopamine, oxygenation, and many other outcomes are also likely to come into play.
Comparing this to pharmaceutical or behavioural therapies, I can see why they'd be as effective. You're treating the entire system, not just trying to change a single chemical in the brain, specifically when we aren't even measuring the chemical before or after treatment.
That since for 100,000 years humans were roaming the landscape gathering or hunting, and for 10,000 years engaged in heavy agricultural work, is the modern day rise in depression not just correlated but caused by the modern day reduction in daily heavy exercise?
It’s such an obvious idea I am wondering if folks know of any research / studies on it?
Don't underestimate the meaning and relationships people had in those times, hunting together to feed your family, farming with your community and interacting with animals etc.
I think physical activity, even just going on walks makes one feel change is possible. If something sucks and I sit home all day on YouTube, then it continues to suck. If I can change my environment, do things outside, see new people and find myself if different situations, then the thing that sucks starts feeling like maybe it also could change.
For example I doubt exercising in a basement just by yourself on 1 machine is likely to materially help with depression. At least not as much as going out doing a variety of things, or playing a game of basketball at the local gym/community center.
Yeah. I think the communitarian point is valid, and valuable. Also, even if you only do that 1 machine thing in the basement, you can regard it as an achievement that's worth something. At least I did that thing. It makes me feel kinda ok too, or just better.
I exercised for years. I’m talking multiple hours a day. It was a part time job. It never improved my mood.
Some people don’t suffer from chemical imbalances, unhealthy habits ruining their mood, or whatever your snake oil will magically cure. There’s a term called Shit Life Syndrome and some people just have that as their long term situation.
Extremely disappointing analysis in the article and also the cited paper's abstract [0]. The only way this data could possibly hold any value is if they found a way to control for how depression might influence an individual's likelihood of choosing to participate in the trial in the first place, as well as trial completion rates.
Even an amateur could read the headline and instantly understand this critical point the experiment's design, and yet it's not even acknowledged under the "Risk of bias" section.
60 comments
[ 0.22 ms ] story [ 95.2 ms ] threadExhortation to develop those good habits in the good times, I suppose.
From studies like this, maybe more awareness and perhaps funding to solutions providing smaller steps
Shameless plug, I am building one: Low friction mini games, social, squats/situps/pushups. Feelgoodcrew.com
I'm not a big believer in discipline.
The most important thing to get started with working out is just to start doing some exercise. You can start on one push up a day or something. It's all about creating momentum and habit.
Once you do it, then you can increase the time and the intensity and optimize exercise and all. But doing sport should be about doing one push up a day and thats it. About starting as slow as you can.
Sleep is the same in that we try to sleep as much as we can, and get as much REM and deep sleep, and these are not the right metrics for most people. The most important is just to go to bed and wake up at the same time everyday. That's it.
People are obsessed with trying to go to sleep at some point in time. Don't. Go to sleep when you're tired, wake up sleep deprived at the right time, the next evening it'll be easier to sleep at the right time
This seems to work for me at least. If I start trying to reason with myself why I should get out of bed at 5am to go to the gym rather than excuse XYZ, I will talk myself out of it.
If I simply start "moving" and start doing "stuff" without engaging my brain, things happen and within a short space of time, I'm pumping iron and feeling great.
A LOT of quiet unassuming people are INSPIRINGLY motivated to push through INCREDIBLE pain and obstacles, every day. Many that prevent them from 'just exercising until life gets better'. It is bullshit to say they lack motivation/character/willpower.
If therapy for depression were a pill, I'm not sure it'd demonstrate enough efficacy to get approved.
One of the most frustrating things when your really low is people giving advice like do exercise to feel better - please don’t do this.
https://www.ucl.ac.uk/news/2022/jul/analysis-depression-prob...
Exercise was how I stayed mildly sane for a good majority of those years, but when I started taking medication it was like the entire world changed. I wish I had started earlier in life. It helped me to become a lot more introspective as well, being able to better examine why I was feeling the way I did.
There are some things that no amount of exercise or "healthy living" can fix, that's unfortunately just the human condition. It's nothing to be ashamed of.
> For the 57 trials (2189 participants) comparing exercise with no treatment or a control intervention, the pooled SMD for depressive symptoms at the end of treatment was −0.67 (95% confidence interval (CI) −0.82 to −0.52; low‐certainty evidence), showing that exercise may result in a reduction in depressive symptoms. When we included only the seven trials (447 participants) with adequate allocation concealment, intention‐to‐treat analysis and blinded outcome assessment, the pooled SMD was smaller (SMD −0.46, 95% CI −0.88 to −0.04). Pooled data from the nine trials (405 participants) with long‐term follow‐up provided very uncertain evidence about the effect of exercise on depressive symptoms (SMD −0.53, 95% CI −1.11 to 0.06; very low certainty evidence).
Like, what does -0.67 really mean in this context. I read the study and it is not really explained. Maybe I'm too dumb to get it, though.
ssri don’t fix any underlying condition and barely work long term, that if they really work at all.
It's unhelpful because I got tired, and then I stopped workout entirely
Now I just do fast walking and it's nice
Try HIIT 1 minute walking, 1 minute running
stimulating for the brain, safe, fun and an easy way to ease into running.
That being said, I do believe that exercising, eating right, maintaining a healthy sleep schedule, etc., all the boring lifestyle things have been key to preventing myself from slipping back into that depressed state, years after stopping medication.
I highly recommend the audiobook as it is read by him and he is very enthusiastic about his research.
The one quote I remember from the book is that he stopped prescribing Prozac and started prescribing treadmills...
It's in my top 15 books that changed my worldview.
Some key highlights:
1. In 2001 fit kids scored twice as well on academic tests as their unfit peers.
2. German researchers found that people learn vocabulary words 20 percent faster following exercise than they did before exercise, and that the rate of learning correlated directly with levels of BDNF.
3.Specifically, every fifty minutes of weekly exercise correlated to a 50 percent drop in the odds of being depressed.
Standardized effect sizes like the ones reported here have no clinical meaning, they are purely statistical. To measure if these kinds of changes matter, you need to determine the Minimal (Clinically) Important Difference [1-2]. I.e. can clinicians (or patients) even notice the observed statistical difference.
In practice, this is a change of about 3-5 points on most 20+ item rating scales, or a relative reduction of 20-30% of the total (sum) score of the scale [1-2]. Unfortunately, anti-depressants are under or just barely reach this threshold [3-4], and so should be widely to be considered ineffective or only borderline effective, on average. Of course this is complicated by the fact that some people get worse on these treatments, and some people experience dramatic improvements, but, still, the point is, depression is extremely hard to treat.
EDIT: There is less data on MCIDs for therapy, but at least one review suggests therapy effects can be in the 10+ point range [5]. But the way the exercise study is presented, with a standardized effect size, we can have no idea if the results matter at all [6].
[1] Button, et al. (2015). Minimal clinically important difference on the Beck Depression Inventory - II according to the patient’s perspective. Psychological Medicine, 45(15), 3269–3279. https://doi.org/10.1017/S0033291715001270 [https://www.cambridge.org/core/journals/psychological-medici...]
[2] Masson, S. C., & Tejani, A. M. (2013). Minimum clinically important differences identified for commonly used depression rating scales. Journal of clinical epidemiology, 66(7), 805-807. [https://www.jclinepi.com/article/S0895-4356(13)00056-5/fullt...]
[3] Hengartner, M. P., & Plöderl, M. (2022). Estimates of the minimal important difference to evaluate the clinical significance of antidepressants in the acute treatment of moderate-to-severe depression. BMJ Evidence-Based Medicine, 27(2), 69-73. https://doi.org/10.1136/bmjebm-2020-111600 [https://ebm.bmj.com/content/27/2/69.abstract]
[4] Jakobsen, J. C., Gluud, C., & Kirsch, I. (2020). Should antidepressants be used for major depressive disorder?. BMJ evidence-based medicine, 25(4), 130-130. https://doi.org/10.1136/bmjebm-2019-111238 [https://ebm.bmj.com/content/25/4/130.abstract]
[5] Cuijpers, P., Karyotaki, E., Weitz, E., Andersson, G., Hollon, S. D., & van Straten, A. (2014). The effects of psychotherapies for major depression in adults on remission, recovery and improvement: a meta-analysis. Journal of affective disorders, 159, 118–126. https://doi.org/10.1016/j.jad.2014.02.026 [ shevy-java ↗ This kind of makes sense. Most forms of depression have to do with
not wanting to do something or lacking motivation to do so. Whereas
in sports, people get busy usually, they do something, even if it may
just be soccer playing. Exercise is also usually good for one's
physical well-being, blood circulation increases, muscles may improve,
pain may go away (depends on the exercise, but usually say, two days
after some heavy work out, most people may feel better than before,
unless it was some extreme exercise that caused injury). resumenext ↗ Therapy carries a huge risk, so maybe if you compare average outcomes exercise is only nearly as effective, but if you consider the 2 overall exercise comes out way, way ahead imho. isk517 ↗ Exercise is great, just make sure to take sometime to evaluate where you are at mentally. I was running about 40 miles and doing 5 hours of lifting per week to try and stay a head of my depression, and when I finally burnt out everything came crashing down all at once. pedalpete ↗ There is a tri-lateral(?) relationship between exercise, sleep, diet, and how the three impact mental health. lifeisstillgood ↗ This leads to a fairly obvious conjecture : yousif_123123 ↗ Don't underestimate the meaning and relationships people had in those times, hunting together to feed your family, farming with your community and interacting with animals etc. kayo_20211030 ↗ Yeah. I think the communitarian point is valid, and valuable. Also, even if you only do that 1 machine thing in the basement, you can regard it as an achievement that's worth something. At least I did that thing. It makes me feel kinda ok too, or just better. fastasucan ↗ >is the modern day rise in depression bradlys ↗ I exercised for years. I’m talking multiple hours a day. It was a part time job. It never improved my mood. owenpalmer ↗ Extremely disappointing analysis in the article and also the cited paper's abstract [0]. The only way this data could possibly hold any value is if they found a way to control for how depression might influence an individual's likelihood of choosing to participate in the trial in the first place, as well as trial completion rates.
I don't think this works for all type of depression though.
A waste product of exercise is Adenosine. Adenosine build-up leads to increased sleep pressure, and improved Neural Function of Sleep, not just "being unconscious".
This is where things get a bit interesting when we look at depression. For many people, depression results in decreased Neural Function of Sleep (specifically slow-wave activity) even though sleep time often increases.
However there is also some evidence that restricting slow-wave activity can act as a "reset" button. The researchers I have spoken to about this are either in the "too dangerous to do the research" camp, or "distrupting slow-waves for a very short period, then increase slow-wave activity".
Of course, sleep and exercise would only be a single pathway to improving depression outcomes. Exercise alone, and the dopamine, oxygenation, and many other outcomes are also likely to come into play.
Comparing this to pharmaceutical or behavioural therapies, I can see why they'd be as effective. You're treating the entire system, not just trying to change a single chemical in the brain, specifically when we aren't even measuring the chemical before or after treatment.
That since for 100,000 years humans were roaming the landscape gathering or hunting, and for 10,000 years engaged in heavy agricultural work, is the modern day rise in depression not just correlated but caused by the modern day reduction in daily heavy exercise?
It’s such an obvious idea I am wondering if folks know of any research / studies on it?
I think physical activity, even just going on walks makes one feel change is possible. If something sucks and I sit home all day on YouTube, then it continues to suck. If I can change my environment, do things outside, see new people and find myself if different situations, then the thing that sucks starts feeling like maybe it also could change.
For example I doubt exercising in a basement just by yourself on 1 machine is likely to materially help with depression. At least not as much as going out doing a variety of things, or playing a game of basketball at the local gym/community center.
I think it was quite hard to get an appointment for a depression diagnosis 100,000 years ago.
Some people don’t suffer from chemical imbalances, unhealthy habits ruining their mood, or whatever your snake oil will magically cure. There’s a term called Shit Life Syndrome and some people just have that as their long term situation.
Even an amateur could read the headline and instantly understand this critical point the experiment's design, and yet it's not even acknowledged under the "Risk of bias" section.
[0] https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...